Anaemia during pregnancy ?

What is anaemia?

Anaemia is a lack of red blood cells, which can lead to a lack of oxygen-carrying ability, causing unusual tiredness.
The deficiency occurs either through the reduced production or an increased loss of red blood cells.
These cells are manufactured in the bone marrow and have a life expectancy of approximately four months.
To produce red blood cells, the body needs (among other things) iron , vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.

What are red blood cells?

Red blood cells are the cells that circulate in the blood plasma (fluid) and give blood its red colour.
Through its pumping action, the heart propels the blood around the body through the arteries.
The red blood cells obtain oxygen in the lungs and carry it to all the body's cells.
The cells use the oxygen to fuel the combustion (burning) of sugar and fat, which produces the body's energy.


During this process, called oxidation, carbon dioxide is created as a waste product.
It binds itself to the red blood cells that have delivered their load of oxygen.
The carbon dioxide is then transported via the blood in the veins back to the lungs where it is exchanged for fresh oxygen by breathing.

Causes of anaemia during pregnancy

Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased.
The mother must increase her production of red blood cells and, in addition, the foetus and placenta need their own supply of iron, which can only be obtained from the mother.
In order to have enough red blood cells for the foetus, the body starts to produce more red blood cells and plasma.
It has been calculated that the blood volume increases approximately 50 per cent during the pregnancy, although the plasma amount is disproportionately greater.
This causes a dilution of the blood, making the haemoglobin concentration fall.
This is a normal process, with the haemoglobin concentration at its lowest between weeks 25 and 30.
The pregnant woman may need additional iron supplementation, and a blood test called serum ferritin is the best way of monitoring this.
Other causes include:
a diet low in iron. Vegetarians, and dieters in particular, should make sure their diet provides them with enough iron lack of folic acid in the diet, or more rarely, a lack of vitamin B12 loss of blood due to bleeding from haemorrhoids (piles) or stomach ulcers anaemia is more common in women who have pregnancies close together and also in women carrying twins or triplets.

What are the symptoms of anaemia during pregnancy?

If the woman is otherwise healthy, she will rarely have any symptoms of anaemia unless her haemoglobin (red pigment) is below 8g/dl.
The first symptoms will be tiredness and paleness. Palpitations – the awareness of the heartbeat, breathlessness and dizziness can occur, though they are unusual. If the anaemia is severe (less than 6g of haemoglobin per decilitre of blood), it may cause chest pain (angina) or headaches .

What can be done to avoid anaemia during pregnancy?

Be sure to get a varied diet. If planning a pregnancy, talk to a doctor or midwife about food and supplements – if possible, before becoming pregnant. Good sources of iron are beef, wholemeal bread and cereals, eggs, spinach and dried fruit. Supplementing the diet with iron , vitamins and especially folic acid. Taking 400 micrograms folic acid when pregnant is important to reduce the risk of having child with spina bifida. A doctor may advise taking combined iron and folic acid supplements before becoming pregnant. To absorb the maximum amount of iron from the diet, it will help to also eat a diet rich in vitamin C. Raw vegetables, potatoes, lemon, lime and oranges are all good sources of vitamin C. Foods rich in folic acid include beans, muesli, broccoli, beef, Brussels sprouts and asparagus. A pregnant woman should take notice of her body's signals and consult a doctor if any symptoms occur. It is now routine to recommend to women planning a pregnancy to take a folic acid supplement for the first 12 weeks of pregnancy and preferably starting before conception. This reduces the risk of spinal cord defects (spina bifida) developing in the foetus.

How does a doctor diagnose anaemia during pregnancy?

Apart from the clinical symptoms, anaemia is usually detected during antenatal screening. Blood tests are usually done at the first consultation, and again in the second half of pregnancy.
A description of the red blood cells – their different form and colour will be included in the result of the blood test.
In women of Afro-Caribbean or Mediterranean origin, additional tests are performed to screen for genetic causes of anaemia, namely sickle cell anaemia and thalassaemia.
Possible complications of anaemia
Difficulty in breathing, palpitations and angina . Severe anaemia due to loss of blood after the delivery. If this occurs, then a woman may be advised to have a blood transfusion.

How will a doctor treat anaemia during pregnancy?

A doctor will examine the expectant mother and prescribe any necessary treatment for anaemia, such as vitamins or minerals .
Iron tablets can often cause constipation or diarrhoea and some women simply cannot take them.
Side-effects on the gut can be resolved by taking the iron with or after food or by starting with a low dose and increasing gradually – talk to your doctor about this.

Iron supplements for non-anaemic pregnant women
Anaemia in women is often associated with low birth weight and preterm births, but that does not mean that women should be taking iron pills, or any vitamin pills indiscriminately, to prevent poor pregnancy outcomes.
Women who are not suffering from anaemia should ensure that they receive proper advice on diet and nutrition from their doctors and midwives.
Iron supplements may have a harmful effect on women who do not need them in the first place.

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How body temperature increases in FEVER ?

What is fever ?

Whenever any bacteria or virus inters into our body our body temperature increases from normal is called FEVER.

Normal Body Temperature

.37 degree celcius and in fahrenhiet is 98.6 degree.

In our bloodstreams pyrogens are flow. pyrogens are chemical whenvever pyrogens are come in contact with any bacteria or virus then body temperature increases. as you know that hypothalamus is the incharge of regulation of body temperature. so these pyrogens by bloodstream reach to the hypothalamus in brain and attach to the some receptors of hypothalamus and give the signal to increase the temperature.

Pyrogens are of different types but Interleukin-1 is common pyrogens. IL-1 is produced by white blood cells called macrophage cells. when these interleukin come in contact with any bacteria or virus . interleukin has many purpose first is that to activate other white blood cells called T helper cells. One of to increase the temperature of body by attaching receptors of hypothalmus in brain.

Interleukin increase the temperature becoz its wants to make unfavorable condition for particular bacteria or virus and destroy them.

One of the most common debate is that increase of temperature during FEVER is good or not ?

The reality is that increase of temperature is good for patients of FEVER.

Diagnosis

Increase of temperature from normal. Normal temperature is

37 degree celcius and in fahrenhiet is 98.6 degree.

Treatment

Aspirin or Paracetamol for example, will reduce fever; but if the fever is actually helping rid the body of infection, then lowering it might not be a good idea. On the other hand, people sometimes die from fever. Right now the general medical consensus falls on the "reduce the fever" side of the fence.

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Fully described Amoebic dysentery and its treatment?

What is amoebic dysentery?

There are several different species of amoebae, but the most dangerous, such as Entamoeba histolytica, live predominantly in tropical areas.
These species are able to burrow through the intestinal wall and spread through the bloodstream to infect other organs, such as the liver, lungs and brain.
Amoebic dysentery (amoebiasis) is an infection of the intestine (gut) caused by an amoeba called Entamoeba histolytica that, among other things, can cause severe diarrhoea with blood.
But it may cause milder chronic symptoms of:

• frequent loose stools
• abdominal pain
• cramps
• fatigue
• intermittent consitipation. 
• diarrhoea with abdominal swelling
• flatulence.

Amoebae are parasites that are found in contaminated food or drink. They enter the body through the mouth when the contaminated food or drink is swallowed.
The amoebae are then able to move through the digestive system and take up residence in the intestine and cause an infection.

How do you get amoebic dysentery?

Entamoeba histolytica can exist in two forms in contaminated food and drink:

• as free amoebae (known as 'trophozoites')
• as infective cysts, which are a group of amoebae surrounded by a protective wall, that have been passed (excreted) in the carrier's faeces (human or animal).

If you swallow contaminated food that contains the free amoebae (trophozoites), hardly anything is likely to happen because they usually die in the stomach on account of its acidity.
On the other hand, cysts are particularly resistant to the acidic contents of the stomach, and food contaminated with cysts represents a genuine risk of infection.
When the cysts reach the intestine of another person, the individual amoebae are released from the cysts and are able to cause infection.
Amoebic dysentery is passed on by careless or negligent hygiene, where contaminated food and drink is consumed without adequate heat treatment.
Salads washed with contaminated water are a common method of spread.

What does amoebic dysentery feel like?

Amoebic dysentery may not demonstrate any symptoms for long periods of time (months, even years). But infected individuals still excrete cysts and, consequently, infect their surroundings.
When the amoebae attack, they damage the walls of the large intestine – causing ulceration and subsequent bleeding.
The milder symptoms of this are:

• stomach cramps (colic)
• painful passage of stools (tenesmus)
• bloody, slimy diarrhoea that's often foul smelling.

But the course of the disease can become complicated and alter radically if the amoebae break through the intestinal wall and its lining (peritoneum), causing peritonitis (inflammation of the peritoneum).
The amoebae may be transported via the blood to the liver and other organs and usually do NOT give rise to a high temperature (this can be useful ie bloody diarrhoea with a fever suggests a bacterial infection) and a seriously debilitated condition.
In the long term, the amoebae can, among other things, form enormous cysts in the liver and other organs, which sometimes may only be discovered on investigation by a doctor for other conditions, such as unexplained weight loss or illness.

What can you do to help yourself?

In practice, the only way to avoid infection with amoebic cysts is to ensure that everything you eat or drink has been washed or sterilised properly and cooked thoroughly.
Drinking water can be made safe in two ways:

• by boiling it for 10 to 15 minutes (a little longer at high altitudes), and then cooling it rapidly and keeping it covered
• by adding water-purifying tablets and then leaving the mixture to stand for at least 15 minutes before use
• by using a filtration device such as Aquapure Traveller (combined ceramic and chemical filters) or Lifesaver system.

Chemical methods of sterilisation do not, however, guarantee complete destruction of all possible harmful organisms.
Foods to avoid include salads, unpeeled fruit and ice cream.
Ice cubes may also have been made with contaminated water. So, avoid having drinks that contain ice cubes, unless you're certain that the water used to make them has been sterilised.

Diagnosis

Anyone who develops bloody diarrhoea should see a doctor as soon as possible and ensure that they tell the doctor they have been travelling in the tropics, as amoebic dysentery doesn't normally occur in the UK.
In the presence of the classic symptoms of amoebic dysentery, the diagnosis can often be made by means of a stool analysis.
Bloody diarrhoea is seen in many other illnesses, but in tropical areas the diagnosis will typically be either amoebic dysentery or shigellosis (bacillary dysentery which is caused by bacteria and more likely associated with a fever).

Treatment

Amoebic dysentery is treated with metronidazole or tinadazole.
A problem arises in that some of the parasites will not respond to treatment and the medicines required to totally get rid of the disease after the above treatment are not readily available (ie Paromomycin o diloxanide furoater).
Complications, such as perforation of the intestinal wall or the presence of abscesses within the body's organs, require specialist hospital treatment.
In an emergency for instance, if you have bloody diarrhoea and are on holiday in the tropics and cannot get medical help: you can treat yourself with metronidazole, eg two 400mg tablets, three times a day for five days. This is the dose for adults who are neither pregnant nor breastfeeding.
It's important to avoid drinking alcohol during treatment. Even if you have to treat yourself, it's important to see a doctor to ensure that the treatment has been truly effective.
UK General Practitioners are not supposed to provide NHS prescriptions for travellers away for longer than three months.
As metronidazole requires a prescription, you could ask your own doctor or travel clinic to write a private prescription in advance if you know that you will be travelling to remote tropical areas where access to a doctor or hospital may be difficult.
Such prescriptions need to be issued privately, ie the cost of the drug has to be paid in full to the pharmacist.                                     

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Detailed about Ovarian Cysts ?

What are ovarian cysts?

A woman's ovaries contain numerous immature eggs some of which mature and develop over the course of a woman's life until the menopause.
In normal women an egg is produced every month. The egg finds its way to the Fallopian tube, where it may be fertilised if sperm are present.
Sometimes cysts may develop. These are often filled with liquid and are almost always benign.
Cysts can occur from one month to the next and may result from an egg which fails to mature. They may burst and thus disappear on their own.
If you have a simple cyst, there's a 60 per cent chance it will disappear after 12 weeks.
If they're over 6cm in size, they are unlikely to disappear naturally and removal should be considered.

What are the symptoms of ovarian cysts?

Most ovarian cysts produce no symptoms and women are unaware of their presence.
However, if a cyst ruptures, twists, or if there is bleeding into the middle of the cyst, then one-sided lower abdominal pain is possible.
Sometimes the cyst can be large enough to put pressure on the bladder (making you feel as they you want to pass urine all the time) or bowel, they may be disturbed during intercourse causing discomfort or pain during penetration.
Ovarian cysts can be associated with other conditions – such as cancer, endometriosis , fertility drugs or early pregnancy.
The risk of ovarian cancer is dependant on the womans age being rare under the age of 40.
The likelihood of cancer is dependant on a number of factors, a combination being more significant than a single feature.

How are ovarian cysts diagnosed?

Ovarian cysts are usually diagnosed on a pelvic ultrasound, but may also be picked up on CT or MRI scan.
If they are large, they may be felt at the time of a pelvic[internal] examination.

What will the doctor do?

Depending on the severity of symptoms and what the risk factors are will determine the management options.

• If the cyst is likely to be benign, asymptomatic and less than 4cm the doctor will probably reassure you and rescan in 12 weeks.
• If over 6cm removal is usually recommended.
• If more than 4 and less than 6cm, a repeat ultrasound in 4 to 6 weeks to check for a change in size.

The doctor may advise removing the cyst. Cysts are usually removed using laproscopic (keyhole) surgery, although not all cysts are suitable for removal in this way.

Ovarian cysts in postmenopausal women

It is recommended that ovarian cysts in postmenopausal women should be assessed using CA125 and transvaginal grey scale sonography. There is no routine role yet for Doppler, MRI, CT or PET.
In order to triage women, an estimate needs to be made as to the risk that the ovarian cyst is malignant. This needs to be done using tests that are easily available in routine gynaecological practice.
At present, these tests are serum CA125 measurement and ultrasound. Serum CA125 is well established, being raised in over 80 per cent of ovarian cancer cases and, if a cut-off of 30 u/ml is used.
Ovarian cysts should normally be assessed using transvaginal ultrasound because this appears to provide more detail and hence offers greater sensitivity than the transabdominal method.
The roles of other imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET), in the diagnosis of ovarian cancer have yet to be clearly established.
It's recommended that a 'risk of malignancy index’ should be used to select those women who require primary surgery in a cancer centre by a gynaecological oncologist.
The best prognosis for women with ovarian cancer is offered if a laparotomy and full staging procedure is carried out by a trained gynaecological oncologist.
Most cysts will be benign, gynaecologists in units at more local level will perform the majority of surgery. It should be appreciated, however, that no currently available tests are perfect, offering 100 per cent specificity and sensitivity. Ultrasound often fails to differentiate between benign and malignant lesions, and serum CA125 levels, although raised in over 80 per cent of ovarian cancers, is raised in only 50 per cent of stage I cases.
In addition, levels can be raised in many other malignancies and in benign conditions, including benign cysts and endometriosis.
Those women who are at low risk of malignancy also need to be triaged into those where the risk of malignancy is sufficiently low to allow conservative management, and those who still require intervention of some form.

Non-invasive treatment

Simple, unilateral, unilocular ovarian cysts, less than 5 cm in diameter, have a low risk of malignancy. It is recommended that, in the presence of a normal serum CA125 levels, they be managed conservatively.
Numerous studies have looked at the risk of malignancy in ovarian cysts, comparing ultrasound morphology with either histology at subsequent surgery or by close follow up of those women managed conservatively.
The risk of malignancy in these studies of cysts that are less than 5cm, unilateral, unilocular and echo-free with no solid parts or papillary formations is less than 1 per cent. In addition, more than 50 per cent of these cysts will resolve spontaneously within three months.
It's reasonable to manage these cysts conservatively, with a follow-up ultrasound scan for cysts of 2 to 5cm, a reasonable interval being four months. This, of course, depends upon the views and symptoms of the woman and on the gynaecologist’s clinical assessment.

Surgical treatment

Those women who do not fit the above criteria for non-invasive treatment should be offered surgical treatment.
Aspiration is not recommended for the management of ovarian cysts in postmenopausal women. Cytological examination of ovarian cyst fluid is poor at distinguishing between benign and malignant tumours.
In addition, there's a risk of cyst rupture and, if the cyst is malignant, there is some evidence that cyst rupture during surgery has an unfavourable impact on disease free survival.
Aspiration, therefore, has no role in the management of asymptomatic ovarian cysts in postmenopausal women.

Laparoscopy

The laparoscopic management of benign adnexal masses is well established. However, when managing ovarian cysts in postmenopausal women, it should be remembered that the main reason for operating is to exclude an ovarian malignancy.
If an ovarian malignancy is present then the appropriate management in the postmenopausal woman is to perform a laparotomy and a total abdominal hysterectomy, bilateral salpingo-oophorectomy and full staging procedure.
The laparoscopic approach should therefore be reserved for those women who are not eligible for non-invasive treatment but still have a relatively low risk of malignancy.
Women who are at high risk of malignancy, as calculated using the risk of malignancy index, are likely to need a laparotomy and full staging procedure as their primary surgery.
It's recommended that laparoscopic management of ovarian cysts in postmenopausal women should involve oophorectomy (usually bilateral) rather than cystectomy.
In a postmenopausal woman, the appropriate laparoscopic treatment for an ovarian cyst, which is not suitable for conservative management, is oophorectomy, with removal of the ovary intact in a bag without cyst rupture into the peritoneal cavity.
There is the risk of cyst rupture during cystectomy and, as described above, cyst rupture into the peritoneal cavity may have an unfavourable impact on disease-free survival in the small proportion of cases with an ovarian cancer.
If a malignancy is revealed during laparoscopy or subsequent histology, it's recommended that the woman is referred to a cancer centre for further treatment.
If an ovarian cancer is discovered at surgery or on histology, a subsequent full staging procedure is likely to be required. A rapid referral to a cancer centre is recommended for those women who are found to have an ovarian malignancy.
Secondary surgery at a centre should be performed as quickly as feasible.
All ovarian cysts that are suspicious of malignancy in a postmenopausal woman, as indicated by a high risk of malignancy index, clinical suspicion or findings at laparoscopy, are likely to require a full laparotomy and staging procedure.

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